Economic Evaluations of Internet-Based Psychological Interventions for Anxiety Disorders and Depression: A Systematic Review

Abstract

Background: Internet-based interventions show clinical effectiveness for treating anxiety disorders and depression and could make mental healthcare more affordable.

Methods: We searched databases including PubMed; EMBASE; Cochrane Central; PsychINFO; CINAHL; EconLit; and Web of Science from January 1, 2000 to August 21, 2020. Inclusion criteria were: 1) pertained to the treatment or prevention of anxiety disorders or depression; 2) evaluated the use of an internet-delivered psychological intervention; 3) recruited participants; and 4) reported costs or cost-effectiveness.

Results: Of the 6,069 articles identified, 33 targeted anxiety (N=13) and depression (n=20) and met final inclusion criteria. All studies were from high-income countries. The control conditions and cost components included were heterogeneous. Only eight studies reported costs of developing the intervention. Of 27 studies that made a conclusion about cost-effectiveness, 81% of interventions were cost-effective. The quality of studies included was high based on a quality assessment checklist of economic evaluations, although many studies did not include definitions of cost components or differentiate between patient-side and system-level costs.

Limitations: Studies varied in methodology, making conclusions about cost-effectiveness difficult. The generalizability of these results is unclear as studies were clustered in a small number of high-income countries and costs vary over time and between regions.

Conclusions: Internet-delivered interventions appeared to be cost-effective although control conditions and cost component reporting were variable. We propose a checklist of cost components for future cost analyses to better compare intervention costs. More research is needed to describe development costs, cost-effectiveness in low-resource settings, and cost-effectiveness of newer technologies.

Figure 1.

Flow diagram of studies included in the systematic review

Figure 2.. Delivery costs

Per participant costs. All dollar amounts in 2015 USD. [] indicates publication year if data collection year was not reported. Some studies reported two interventions; these are shown on separate lines.

Figure 3.. Intervention ICERs

Per QALY gained. All dollar amounts in 2015 USD. All negative ICERs indicate lower costs and greater QALYs in the intervention. [] indicates publication year if data collection year was not reported. *Indicated development costs included in ICER. Some studies reported two interventions; these are shown on separate lines.